Freeport NIP(7.4)-LR000913CITY OF LEW~,.,v'ILLE LABORATORY - WATER BAC .-RIOLOGY
ame of Wat leto ' ~"~
Point of Collection Collected By Dale Time
(.Mo/Day/Yr)
Address: STREET
TELEPHONE(,? ~ ~ ) "~ '~ '~'_ 2 ~'~ (ZIp Code)
Water Systers Identification Nursber .~
OF [] Other
SAMPLE [] Distribulion [] Special [:~onslruction ~~ =>
[] Repeal for sample #
[] Recheck for sample #
[] Other ro "
WATER [-I River [] Lake [] Well
SOURCE:
Well deplh Chlorine Residual
ANALYTICAL METHOD & RESULTS: ~
Present/Absent: Total Col/for Present _
M.RN. Total Coliform /100ME
Membrane Filter/Fecal Coliform; 1st Oil. ..' mi 2nd ,' mi -~
Unsuitable For Analysis:
[] Form Inoon~)lele (see encircled item)
[] Sample too old, nct received within 30 hours of collection
[] Excessive chlorine pressnl in sample
[] Unsuitable container
[] Heavy, non coliform bacteria/silt present, possibly obscuring and compromising lest results
[] Quantity too great !o permit agitalion
[] Quantity insufficienl for analysis (100 mi minmum) ...~
Analyzed by ·
Water' of satisfactory ba~erological quality sho~JId be flee fi'om Coliform Organ/ams.